In situ normothermic regional perfusion versus ex situ normothermic machine perfusion in liver transplantation from donation after circulatory death.
Authors
Nasralla, David
Butler, Andrew
Jassem, Wayel
Imber, Charles
Monbaliu, Diethard
Perera, M Thamara PR
Laing, Richard W
García-Valdecasas, Juan Carlos
Paul, Andreas
Dondero, Federica
Cauchy, François
Scatton, Olivier
Robin, Fabien
Sulpice, Laurent
Bucur, Petru
Salamé, Ephrem
Pittau, Gabriella
Allard, Marc-Antoine
Pradat, Pierre
Ploeg, Rutger J
Friend, Peter J
Mirza, Darius F
Consortium for Organ Preservation in Europe (COPE)
Publication Date
2022-06-03Journal Title
Liver Transpl
ISSN
1527-6465
Publisher
Wiley
Language
en
Type
Article
This Version
AO
VoR
Metadata
Show full item recordCitation
Mohkam, K., Nasralla, D., Mergental, H., Muller, X., Butler, A., Jassem, W., Imber, C., et al. (2022). In situ normothermic regional perfusion versus ex situ normothermic machine perfusion in liver transplantation from donation after circulatory death.. Liver Transpl https://doi.org/10.1002/lt.26522
Abstract
In situ normothermic regional perfusion (NRP) and ex situ normothermic machine perfusion (NMP) aim to improve the outcomes of liver transplantation (LT) using controlled donation after circulatory death (cDCD). NRP and NMP have not yet been compared directly. In this international observational study, outcomes of LT performed between 2015 and 2019 for organs procured from cDCD donors subjected to NRP or NMP commenced at the donor center were compared using propensity score matching (PSM). Of the 224 cDCD donations in the NRP cohort that proceeded to asystole, 193 livers were procured, resulting in 157 transplants. In the NMP cohort, perfusion was commenced in all 40 cases and resulted in 34 transplants (use rates: 70% vs. 85% [p = 0.052], respectively). After PSM, 34 NMP liver recipients were matched with 68 NRP liver recipients. The two cohorts were similar for donor functional warm ischemia time (21 min after NRP vs. 20 min after NMP; p = 0.17), UK-Donation After Circulatory Death risk score (5 vs. 5 points; p = 0.38), and laboratory Model for End-Stage Liver Disease scores (12 vs. 12 points; p = 0.83). The incidence of nonanastomotic biliary strictures (1.5% vs. 2.9%; p > 0.99), early allograft dysfunction (20.6% vs. 8.8%; p = 0.13), and 30-day graft loss (4.4% vs. 8.8%; p = 0.40) were similar, although peak posttransplant aspartate aminotransferase levels were higher in the NRP cohort (872 vs. 344 IU/L; p < 0.001). NRP livers were more frequently allocated to recipients suffering from hepatocellular carcinoma (HCC; 60.3% vs. 20.6%; p < 0.001). HCC-censored 2-year graft and patient survival rates were 91.5% versus 88.2% (p = 0.52) and 97.9% versus 94.1% (p = 0.25) after NRP and NMP, respectively. Both perfusion techniques achieved similar outcomes and appeared to match benchmarks expected for donation after brain death livers. This study may inform the design of a definitive trial.
Keywords
ORIGINAL ARTICLE, ORIGINAL ARTICLES
Sponsorship
European Commission Seventh Framework Programme Grant (305934)
Identifiers
lt26522, lt-21-715.r2
External DOI: https://doi.org/10.1002/lt.26522
This record's URL: https://www.repository.cam.ac.uk/handle/1810/338616
Rights
Licence:
http://creativecommons.org/licenses/by-nc/4.0/
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